Alternatives to PayorLink
Compare PayorLink alternatives for your business or organization using the curated list below. SourceForge ranks the best alternatives to PayorLink in 2026. Compare features, ratings, user reviews, pricing, and more from PayorLink competitors and alternatives in order to make an informed decision for your business.
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NovusMED
Momentm
NovusMED is an ecosystem that includes call center, administrative, driver applications, and client/clinic booking applications. NovusMED is the platform of choice for a wide range of medical transportation services and includes configurations for brokerage, providers, senior, community, and home health programs. Accurately manage calls and patient information. Monitor real-time performance and adjust resource capacity to meet changes in service demand. Manage will calls, confirmation calls, and recurring trips/standing orders in real time. Improved mileage reimbursement and cost calculators to manage multiple contractors, funding sources (payors), multiple providers, and volunteer driver programs. Enhanced credential management for vehicles and drivers. Manage subcontractor outsourcing with provider mobile, trip bidding, and trip offers. Able to see the closest vehicle and perform immediate bookings. -
2
AZZLY
AZZLY
AZZLY Rize is the premier clinical and business platform for addiction treatment and mental health organizations. As an all-in-one substance use disorder and mental health specific EHR, Patient Engagement and RCM platform, we serve small, medium, and large clinics. Key features for OUTPATIENT Programs include: scheduling, appointment reminder, Zoom telehealth, treatment plans, progress notes, assessments and surveys. For RESIDENTIAL programs: census, medication management, bed board, withdrawal management, DrFirst e-prescribing, EPCS, PDMP, labs. For all levels of care: alerts, patient engagement portal, electronic billing and claims submission built in. AZZLY Rize empowers your staff through its 5 star training and support services, its simplicity and automation. As a true all-in-one EHR/PM/RCM platform, improved compliance, workflow and accurate billing are achieved real-time. We proudly serve programs in over 33 states and are hosted in Microsoft Azure's private cloud network.Starting Price: $50/user/month -
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MyClaimStatus
Medical Payment Exchange
If your staff is wasting precious time and resources by manually statusing claims on web portals and sitting on the phone with payors you need myClaimStatus. Get real-time, actionable claim status information on all of your claims and eliminate the waste. myClaimStatus’s suite of data tools helps you reconcile claims faster. It doesn’t matter how big or small you are. Save more with every claim when you use myClaimStatus. Are you working efficiently? MedX medical claim services use robotic process automation to maximize your workflow efficiency. Easily reconcile reimbursement rates with your contracted amount ensuring you’re receiving what you should. Drill down with real-time data for every healthcare claim from every payor, no matter the dollar amount. This is not your standard healthcare claims processing software. Optimize AR follow-up activities to work by exception and get more done in less time. -
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iVEcoder
PCG Software
iVECoder, the decisive code tool with payor intellect, was built on the same intelligence of PCG's Virtual Examiner® claims review engine that healthcare payors worldwide have been using for 25 years. Users can enter multiple codes, and in just a single click, receive multiple answers on a single page. Ramp up coding accuracy and boost your bottom line by using the same billing and coding intelligence platform the payors use. iVECoder is PCG's Virtual Examiner® (VE) claims review engine. This advanced rules based engine —with 45 million edits— is used by healthcare payors throughout the USA and abroad. VE tells payors what to deny or pend for review. -
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Dart Chart
Dart Chart Systems
Provide real-time visibility of payor contracts to all your facilities. Easily monitor every payor-required rule for levels, notifications, and pre-authorizations to ensure you never miss a Managed Care reimbursement. Our SMART Recovery team complements your billing staff by pursuing older unpaid claims and reducing bad-debt write-offs. Gain transparency and take action on aged claims. Get started quickly with no upfront cost. Our Smart Recovery team works in your EHR to review the aged claims you assign us. No implementation or training is needed. For SMART Case Manager software, our implementation team handles the heavy lifting of setting up your payor contracts and integrating with your EHR and therapy software. Once it’s set up, your staff can be trained in just 90 minutes. In the first 30 days, you’ll save more time than it takes to launch DART Chart! -
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Brellium
Brellium
Brellium is an AI-powered clinical compliance platform designed to audit clinical documentation, billing, and payor risk across every patient visit. Its core capabilities include real-time chart review using machine learning to check every note, session, and encounter for coding compliance (MDM/E/M/ICD-10), clinical quality standards, payor rules, and documentation integrity, delivering audits up to 13x faster and reducing chart-review costs by approximately 98%. Brellium integrates with any EMR, supports custom and prebuilt audit criteria, sends automatic provider-feedback emails, and provides trend-data dashboards that stack-rank clinicians based on documentation quality. It also offers a unique clawback-protection guarantee: if a payor retracts reimbursement on a Brellium-approved chart, Brellium will cover the cost. The platform serves specialties such as behavioral health, ABA, home health, chronic-care management, and telehealth. -
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Kodiak Platform
Kodiak Platform
Kodiak Platform is a cloud-based healthcare finance and revenue-cycle solution designed to unify and elevate critical financial operations across hospitals, health systems, and physician practices. Built around their proprietary Revenue Cycle Analytics software, the platform aggregates over two decades of national payor and provider data to enable deep insights into net revenue trends, industry benchmarking, and risk accelerators, all aimed at generating a high return on investment. It integrates modules for charge capture, three-way cash reconciliation, uncompensated-care reimbursement, and payor market intelligence, enabling finance teams to automate key processes, gain visibility into unapplied payments, and benchmark payor performance at the payer level. With detailed dashboards, multi-step workflows, and continuous monitoring, users can standardize revenue-cycle tasks, reduce manual effort, and identify growth opportunities from one unified platform rather than siloed systems. -
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DocASAP
DocASAP
DocASAP’s platform simplifies patient access complexities by intelligently matching the needs of patients and providers, while navigating patients through their access journey. Frictionless access is critical but challenging to achieve. DocASAP helps organizations meet clinical and operational goals related to access — and enhance patient engagement. Our platform helps payors like Aetna and UnitedHealthcare work with leading healthcare systems to broaden access through health plan member portals and apps. DocASAP’s COVID-19 Vaccine Scheduling & Engagement solution empowers providers and payors to offer patients and community members appointments for COVID-19 vaccination. DocASAP provides the leading patient access and engagement platform for health systems, health plans and physician groups. -
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CertifyOS
CertifyOS
CertifyOS delivers API-first credentialing, licensing, and enrollment to payors, health systems, and rapidly-scaling digital health companies. We unlock insights and power performance for clinicians, teams, and organizations. Build best-in-class provider networks with our one-click credentialing solution. Real-time, automated NCQA-compliant credentialing to scale provider networks. Automated ongoing monitoring to ensure your provider networks remain compliant. We take the guesswork (and paperwork) out of licensing–so you can scale to new markets, seamlessly. Get in the network and get reimbursed faster, so you can get back to care. Streamlined processes for cross-state licensure in all 50 states for any license category. Streamlined payor enrollment process to get providers in-network in new markets. Track enrollment progress with our individualized dashboards. Leverage our best-in-class methodology to clean, normalize, and enhance your provider data. -
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SpectrumAi
SpectrumAi
Applied Behavior Analysis is the gold-standard therapy to help those with autism achieve their best possible outcome towards independent living, meaningful relationships, lifelong vocation and self-advocacy. Above all, ABA lacks data transparency, keeping everyone – parents, providers and payors – in the dark. We’re improving the quality of ABA therapy with objective data, meaningful insights and actionable nudges. We partner with provider and payor organizations to establish value-based contracting models. -
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ResolvMD
ResolvMD
ResolvMD is an experienced full-service medical billing company that processes all health service claims (AHCIP etc.) on behalf of physicians. Our goal is to make physicians as confident and competent in their billing as they are in their practice through surfacing data-derived insights and democratized knowledge. We have the most modern, cost-effective, and secure platform on the market for processing claims. Our target audience are physicians (mainly specialists such as emergency physicians, urgent care, plastic surgeons, anesthesiologists, paediatricians, general surgeons etc.). They need a billing agent to process their health service claims. They value time, trust, cost, efficiency and knowledge. We are targeting physicians in Alberta today (mainly in Calgary, Edmonton, Red Deer, Medicine Hat, Lethbridge, Okotoks and any other centre with a population in excess of 25,000. -
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EZClaim Medical Billing
EZClaim
EZClaim is a medical billing and scheduling software company that provides a feature-rich practice management system specifically tailored for small to medium-sized provider office and outsourced medical billing firms. It also includes integrations with a number of EMR/EHR vendors. Whether you are a doctor, practice manager, or billing service owner, EZClaim Billing is designed with you in mind, simplifying your claims management from data entry to payment posting, and beyond. EZClaim primarily supports the following specialties, General Practice, Therapy, Vision, Surgical, Medical Specialties, Home Health Care, and Outsourced Medical Billing Services (RCM). However, the software is very adaptable and can be used for many other billing specialties. EZClaim’s billing software allows the creation of insurance payor lists for Medicare, Medicaid, Tricare, Clearinghouse payer IDs, governmental MCO’s, auto insurance, and worker compensation groups. -
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Variate Health
Variate Health
Variate Health offers a unified data and analytics platform designed to break down silos and bring real-time clarity to healthcare operations and patient care. Its Command Center integrates disparate data sources into a cohesive view, delivering geospatial insights and proprietary indices, such as the Healthy Food Ratio (HFR), Healthcare Availability Index (HAI), and Area Stress Index (ASI), to assist health systems, payors, and providers in understanding population health, care access, and environmental stressors. With the platform, teams can visualize the whole patient story, detect operational inefficiencies, and act on insights that drive better outcomes, including reductions in avoidable hospital days, shorter lengths of stay, and improved resource utilization. By layering location-based analytics on top of clinical, claims, and operations data, Variate Health enables organizations to orchestrate care, anticipate demand, coordinate services, and optimize staffing. -
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PayorIQ
Compliance PT
Receive notifications when Payors make policy changes. Staying informed makes all the difference. Instead of reading through hundreds of pages of insurance-speak, our software detects policy changes and writes easy-to-digest notes for your billing and coding staff to implement. Quickly find policy specifics for a given claim date. Use our data as evidence to win more cases.Starting Price: $199 per user per month -
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Camber
Camber
We're on a mission to make behavioral health more available and accessible. At Camber, we build software for behavioral health clinicians to improve the quality of care. We streamline and replace manual efforts so clinicians can focus on what they do best. Camber is a software platform designed to streamline administrative tasks for behavioral health clinicians, enabling them to focus on providing high-quality care. It automates daily claim validations and submissions, incorporating pre-submission error detection and payer-specific claim formatting to enhance accuracy and efficiency. By leveraging AI-driven workflows, Camber has achieved first-pass collection rates of approximately 93%, significantly improving financial outcomes for healthcare providers. The system also offers data-driven insights, assisting clinics in identifying optimal locations for expansion and facilitating payor contract negotiations. -
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MedBillit
MedBillit
MedBillit, a cloud-based clinical and billing software, is ideal for hospice agencies. MedBillit assists users in data entry and the automation of workflows to increase the efficiency of the processes. MedBillit key features include nursing assessments, volunteer tracking, compliance alerts, offline forms, and medication recording. With MedBillit, users can automate the claims filling and billing process by its integration with billing to help monitor treatment charges, payor source files, and spent time on patients.Starting Price: $499.00/month -
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eKlinikMD
eKlinik Healthcare Cloud
eKlinikMD is a comprehensive and evolved clinic information platform configured to prepare the practice in meeting New Normal healthcare requirements and expectations as connected health in delivering patient care, lifetime health and practice revenue. eKlinikMD brings features such as: 10kicks connect, appointment scheduling, cashiering billing, consultation notes documentation, electronic medical record, ePrescription connect3, executive dashboard, front desk reception, inventory management, iPatient-portal NCD connect3, iRefer connect3, iWorldcare healthpoints, laboratory reporting, online text helpdesk, patient biodata index, patient home care connect3, patient relations - CRM, payor panel employee health, pharmacy dispensary, point of sale, queue management, self-q connect3, tele laboratory connect3, tele radiology connect3, telemedicine connect3, vendor information system, and system administration. -
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FidelityEHR
FidelityEHR
Utilize data and clinical information in a way that supports high-fidelity care coordination models and Wraparound principles, data-driven decision making and meeting multi-level requirements for provider agencies, care management entities, and MCOs regarding documentation, billing, etc. Individuals with complex behavioral health, medical health and other needs require care coordination that meets EHR requirements while supporting youth, consumer, and caregiver engagement. FidelityEHR supports high-fidelity care coordination, and team-based planning, and integrates personalized progress. FidelityEHR supports comprehensive care coordination to improve behavioral health outcomes and build resilience for overall health and well-being through simple to use team-based EHR software. FidelityEHR is client-centered and connects youth and families, clinicians, care coordinators, multiple providers, and payors. -
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AMC Health
AMC Health
Our passion drives our purpose to give everyone the power to live healthier, more independent lives in the comfort of their own home. Combined through years of thought-leadership achieved through our direct partnerships with clinicians and their patients. AMC’s superior platform combines more than 17-years of hands-on clinical expertise, plus state-of-the-art technology providing real time patient data. Our platform is the only FDA Class II cleared care management platform, with multiple peer-reviewed studies and the ability to provide seamless connections that bridge the gap for care teams, members (patients) and payors. Members…Their Home. Their Health. Their Lifestyle. AMC Health makes it easy to engage, educate and empower those living with chronic conditions. Enabling clinical intervention and management of health situations, proactively. -
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Transparent Health Marketplace
Transparent Health Marketplace
THM is an open and transparent platform connecting healthcare service providers with carriers, third-party administrators and employers responsible for helping injured workers get the care they need as quickly and cost-effectively as possible. Bringing proven marketplace technology that positively transformed travel, finance and other industries, THM brings much-needed efficiency and transparency to workers’ compensation healthcare. Automating costly manual processes and eliminating expensive middlemen drives unprecedented cost savings to THM’s carrier, TPA and employer clients. THM operates as a platform-as-a-service business model, giving payors the tools to create their own dynamic marketplace of quality providers ready to compete for their business. For providers, the THM platform creates a new channel to access referrals from some of the industry’s largest payors and the ability to control price, optimize resources and maximize revenue by filling more available appointments. -
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CureMD Medical Billing
CureMD
CureMD is an award-winning provider of specialty EHR and billing services to help optimize efficiency, decrease cost, and enhance the patient experience. Our cloud platform enables the seamless exchange of information across multiple platforms, systems, and organizations - driving greater collaboration, productivity, and patient safety. With 20 years of medical billing experience, our team is equipped with advanced technology and operational excellence to take your billing operations forward, whether you are a multi-specialty group or a solo practice. Payor changes are inevitable, but we stay ahead by constantly updating our rules engine: a knowledge base with more than 4 million rules that automatically detects claim issues before submission. This ensures that 96% of our claims get accepted and paid on first submission, helping you collect much faster.Starting Price: $295.00/month -
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SapphireVantage
Novacis Digital
SapphireVantage is an AI-powered health analytics and performance management platform built for healthcare payors, providers, and large programs that need a 360° view of performance and actionable insights across clinical, financial, and operational domains. It harnesses advanced data analytics and artificial intelligence to integrate and analyze diverse healthcare datasets in real time, offering capabilities such as claims analytics, utilization analytics, risk and program integrity analysis, provider performance, consumer engagement metrics, care analytics, denial trends and prevention, contract performance, revenue cycle optimization, and fraud/waste/abuse detection to help organizations improve quality, control costs, boost efficiency, and enhance patient outcomes. It supports self-service analytics, real-time dashboards, predictive insights, and performance monitoring tools to empower data-driven decision-making and reveal underlying patterns and outliers. -
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FastTrack
Infinitus
Infinitus provides an AI-powered solution that helps healthcare businesses streamline administrative tasks and improve employee performance. FastTrack™, Infinitus’ AI copilot, bypasses payor IVR systems and hold times, enabling employees to handle more calls in less time. With features like intelligent call initiation, IVR navigation, and real-time call management, Infinitus boosts productivity, employee morale, and scalability. Designed for healthcare workflows, Infinitus integrates seamlessly with CRMs and EHRs to ensure compliance and scalability without additional staffing. -
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CloudCruise
CloudCruise
A unified API to automate insurance verification, claim status updates, and other RCM processes in insurer web portals. Record once, and automate the rest. CloudCruise is an API to replace manual operations with insurer portals. Scale your operations efficiently & reliably with technology. No more repetitive work in insurer web portals. Match your existing data model with a tailored API spec to fit your requirements. CloudCruise leverages its AI interoperability engine to build automated processes that are triggered by the API call. Interact with payors purely through a simple API call, built to your data model definition. CloudCruise continually monitors execution runs. Alerts will be sent in case of any errors, and our AI will automatically heal the workflows. CloudCruise is HIPAA-certified and offers the highest standards of data security and privacy. -
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Crosby Health Apollo
Crosby Health
Thousands of providers use Apollo by Crosby Health to generate, submit, and track appeals. Reducing the provider burden from clinical denials. Apollo has been trained to understand the clinical context and beats every other medical language model on core metrics. Apollo has been fine-tuned to handle billing tasks with high precision such as auditing, charge capture, and denial management. The fastest clinical language model with the largest context length. Outputs are generated on average at 60 words per second and can intake up to 300 pages. Our AI crafts winning appeal letters for every denial with meticulous arguments for maximum recovery. Eliminate multiple payor portals and fax numbers. One platform that submits and tracks every appeal. Eliminate the provider burden to generate appeals. AI trained to identify medical necessity within documentation. One-click submission to any insurance company. -
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ENTER
ENTER Health
Enter gets Providers (doctors, practices & hospitals) paid faster than anyone in history. Enter processes health insurance claims and pays in 24 hours while automatically communicating and collecting patient responsibility with a white label collection engine, complete with payment plans. Enter is 30x faster at getting claims paid and 45x faster at getting patients billed at the same cost as existing medical billers. - $150mm+ of claims processed in just 1 year of operations. - $100mm credit facility actively being deployed for providers. - Revenue Cycle Management Partner for United Healthcare Nevada. - Enter supports a wide variety of specialties including ASC, Orthopedics, Neurology, Dermatology, Emergency Rooms, Behavioral Health, Pain Management and more. - Enter works with all commercial and government health insurance carriers. - Enter integrates with all EMR / practice management systems. - No monthly fees. No integration fees. - Enter is venture backed -
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Medallion
Medallion
Medallion is the first solution for healthcare companies to fully offload their clinician operations—state license management, payor enrollment, credentialing, and more—in one modern management platform. By empowering digital health companies, hospitals, payers, and other organizations to credential, license, and monitor their providers with ease from one modern platform, they eliminate time-consuming and laborious tasks that ultimately increases accessibility of care to millions of patients nationwide. Since inception in 2020, Medallion has saved over 100,000 administrative hours for leading healthcare companies like Cerebral, Ginger, MedExpress, Oak Street Health, and hundreds more, and has raised $50M from leading investors like Sequoia Capital, Spark Capital, Optum Ventures, Elad Gil, and Peter Reinhardt. -
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Flywheel
Flywheel
Flywheel is the pioneering medical imaging data and AI platform powering healthcare innovation through streamlined data aggregation, curation and management. By leveraging cloud scalability and automating workflows, Flywheel helps organizations turn complex imaging data into analysis-ready datasets for accelerated research and AI development. Flywheel offers comprehensive solutions for pharma companies, providers, payors, system integrators, AI developers and academic medical centers. Leading scientists and researchers turn to Flywheel to accelerate their work and collaborate with ease. Our medical imaging AI platform streamlines the massive tasks of data discovery, aggregation, and curation; automates research workflows; and scales on demand. -
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Netsmart Homecare
Netsmart Technologies
Netsmart Homecare is a fully-integrated system made for any home healthcare organization to streamline everything from patient intake to documentation to scheduling to billing and beyond. Designed by industry professionals and clinicians, Homecare seamlessly combines business, clinical, scheduling, and mobile functionality for multiple lines of business, including home health, hospice, and private duty. With immediate access to vital patient data, notes, and care plans, this homecare software provides true interoperability. It enables real-time data exchange with other providers, maximizing care coordination and leading to improved outcomes. Netsmart Homecare supports your mission to provide care at home with a complete EHR that best suits your agency for today and tomorrow. We know better care requires successful relationships both within and outside of your agency among your patients, payors, staff, and other providers. -
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Microsoft Cloud for Healthcare
Microsoft
Microsoft Cloud for Healthcare is a comprehensive platform designed to transform the healthcare industry through AI-powered solutions, data integration, and secure, connected experiences. The platform helps healthcare providers, payors, and life sciences organizations improve patient care, streamline operations, and enhance research capabilities. It offers tools for safeguarding sensitive data, optimizing clinical workflows, and improving patient engagement. Microsoft Cloud for Healthcare leverages actionable insights from unified clinical and operational data, enabling healthcare organizations to drive positive outcomes, increase efficiency, and reduce costs. -
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AccuShelf
TruMed Systems
Streamline medical inventory management. Simplify inventory control, enhance patient safety, save time, and manage costs in an easy-to-use solution. Reduce waste, loss, and discrepancies with automated scanner-based workflows. Quickly scan every medication barcode to capture lot, expiration, and dosage. Easily confirm dosage and medication prior to administering to patients and eliminate errors. Leverage built-in compliance reports that track every dose by invoice, payor, and provider. Track all medications, vaccines, supplies, and more. Temperature monitoring and alerting on cold storage units. Real-time counts of every dose. The AccuShelf Inventory Management System, allows you to capture every detail about your products in seconds, from the medication strength and appearance to the expiration date and unit quantities, all with a wireless barcode scanner. You can see what’s available in real-time and the system will also notify you of low and critical inventory levels. -
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Enterprise Health Solution
HM Health Solutions
HM Health Solutions provides an end-to-end solution to health plans. Get the support you need and business outcomes you want from one comprehensive health plan administration platform: the Enterprise Health Solution. Platform applications and tools manage functions from sales through enrollment and billing, including claims, provider and clinical management, and customer service. The Enterprise Health Solution (EHS) is the only proven end-to-end solution, and can move your member seamlessly from enrollment to claims payment. You’ve heard others claim to offer a fully integrated solution. What they don’t specify is that you may need to purchase all modules in sequence to achieve this integration. On the Enterprise Health Solution, health plan administration has always been the one and only focus. No other company rivals our expertise in the health plan payer space. -
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StellarHealth
Stellar Health
Who We Work With. For Practicing Physicians. Helping you get paid in real time from health plans for value-based activities that have not been historically reimbursed. Stellar Health eliminates all payor-specific spreadsheets and tools used by practices and instead creates one central application for managing patients, regardless of their health plan. The Stellar Application is a web-based, easy-to-use tool that fits into practice workflows, only prompting providers on items that are actionable in that exact moment. Stellar gets practices paid for the extra few minutes spent going above and beyond for their patients. Providers can also track how much they’ve earned in real time, so practices avoid any end of the year surprises. We offer free support to practicing physicians and gets them paid for all the extra time their practice spends completing value-based activities that have not historically been paid for in the past. -
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PowerMed Billing
PowerMed
PowerMed Billing has been built from the ground up to be state-of-the-art. With its powerful feature set, numerous reporting options and electronic claims processing, it will meet the needs of any busy practice. The software can be configured to each individual user's style, including screen appearance, custom navigation commands, and even individual language settings. It contains a full ICD coding library, customizable CPT, HCPCS, super codes, and enterprise-level patient demographics. Because Billing and EMR are essentially one program, all coded visits and claims are automatically pulled for electronic processing or for standard UB92 or CMS1500 printing. Complete with full search and reporting capabilities, practice managers have immediate access to an extensive library of predefined productivity and financial reports broken down by providers, payors and individual patients. -
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Context 4 Health Plans Suite
Context4 Healthcare
Protect the integrity of your health plan and determine accurate pricing with the Context4 Health Plans Suite, our modular, cloud‑based technology platform. Immediate, actionable, and defensible Fraud, Waste, and Abuse (FWA) detection built by our team of certified clinical, dental, and health benefits experts. Accurate data and cutting-edge cloud technology combine to create a proven and defensible medicare reference-based pricing (RBP) solution. More than 100 healthcare data sets, with professional support to optimize efficiency and compliance. Advanced medical coding software designed to expedite claim submission and minimize denials. Our cloud based Payment Integrity Platform utilizes our proprietary analytics engine to identify coding errors, medical necessity, unbundling, fraud-waste-abuse, audit risks, pricing and other aberrations that can impact your business. -
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WRS Health
WRS Health
We’ve automated and systematized the billing process so your medical practice will get paid correctly the first time and that you will collect the maximum for all services performed. Our cloud-based EHR Software and practice management system provides billers and clinicians with business intelligence and payor rules unrivaled in the industry. Many practices make little effort to market their services. This translates into lost opportunities and flat revenue. WRS provides scalable and sustainable marketing plans for practices of all sizes, specialties and budgets. Now more than ever, physicians are under increased pressure from new rules, increased scrutiny and ever-changing complexities in medical services. We can help remove these burdens, so that you can concentrate on patient care. -
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Insights Platform asks the right questions of the right data sets so you don’t just see the data — you know what to do next. Supported by decades of industry knowledge, act on what you learn, feel more confident in the decisions you make, and see your customers and business operations in ways you never could have before. You’re missing data on customer behaviors that happen outside the four walls of your business. Developing new online portals and guiding pricing decisions is harder than it needs to be. Cross-sell opportunities are unseen and efforts to reduce churn are failing. Patient information that’s captured and tracked across different providers, hospitals and payors traditionally tends to stay within just one organization. Without all the details of a person’s health history you’re unable to provide proactive, individual care and the best options for coverage.
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BaseCase
Certara
BaseCase is the leading value communication and market access platform from Certara. It’s suite of SaaS products enables pharmaceutical, medical device, and diagnostics companies to more effectively engage with payors, healthcare professionals, and other key stakeholders using interactive mobile apps to produce personalized value stories. By uniquely combining ‘no-code’ content creation and integrated value communication on a single platform, BaseCase has changed the ways that life science companies think about product value and how it’s communicated. The complete value communication platform for the life sciences industry. Achieve unparalleled flexibility and speed with integrated content creation and KAM enablement. Create cutting-edge, mobile content without programming and dramatically reduce your workload and costs. Get to market faster with integrated content creation and KAM enablement on one platform. -
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HEALTHsuite
RAM Technologies
HEALTHsuite is a comprehensive benefit administration system and claims processing software solution designed for health plans administering Medicaid and / or Medicare Advantage benefits. HEALTHsuite is a rules-based auto adjudication software solution designed to automate all aspects of enrollment / eligibility, benefit administration, provider contracting / reimbursement, premium billing, medical management, care management, claims adjudication, customer service, reporting and more. RAM’s Medicare Advantage-in-a-Box offering is unique in the industry; the product of RAM’s extensive experience in Medicare Advantage and an unwavering commitment to changing our industry. HEALTHsuite Advantage™ and eHealthsuite™ are the cornerstones of our pre-configured Medicare Advantage-in-a-Box offering. HEALTHsuite Advantage is a fully integrated suite of modules providing our clients with an unmatched solution to administer their Medicare Advantage and Special Needs Plans (SNP’s). -
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CLAIMSplus
Addiox Technologies
Expedited claims. Multiple interfaces sync with your corporate brand. Digitized data environment that can be accessed from anywhere, at any time. Health and Life processing via faster systems that aligns with your processing needs. Speeding up the claims life cycle to match the influx of your claims—while reconciling and resolving the more complicated claims at record velocity. It’s in. It’s out. No interruptions or claims processing delays. CLAIMSplus moves claims faster, working with employers, TPAs and insurers with robust in-the-cloud processing platforms. CLAIMSplusis in the business of optimizing processes and expediting medical claims through secure, reliable and efficient electronic claims management. More to the point, our technology—first and foremost—manages claims quickly and efficiently. We’ve asked our clients, and the timescale of the claim is the most important element for claims processing. -
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Conexia
Conexia
Provide authorizations, claims processing and payment in real-time at the point of care. Enhance care coordination and improved outcomes to lower medical cost while streamlining administrative processes. Engage providers at the point of care to capture and share data in real-time resulting in an unparalleled exchange of health information. We partner with our clients to implement risk management strategies that result in better outcomes with lower costs. We strive to improve the user experience for everyone involved in the ecosystem. We deliver a minimum 3:1 ROI for our clients to allow them to optimize their resources. Conexia has developed a core technology platform (ONE) that is customizable to meet the diverse regulatory requirements and operational processes for each client in each geography. In most cases, our initial implementation is an overlay on the payer’s existing technology ecosystem to create real-time processes. -
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HealthRules Payer
HealthEdge Software
HealthRules® Payer is a next-generation core administrative processing system that provides transformational capabilities to health plans of all types and sizes. For more than ten years, health plans implementing HealthRules Payer have been able to quickly address market opportunities and stay in front of their competition. HealthRules Payer is unlike any other core administrative solution because of its use of the patented HealthRules Language™, an English-like vernacular that delivers a revolutionary new approach to configuration, claims processing and transparency of information. HealthRules Payer helps transform health plans looking to grow, innovate and compete beyond any other core system today. -
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Complete Claims
Complete Health Systems
Claims Adjudication for medical, dental, vision, prescription, short and long-term disability claims. Available for on-site license or as a hosted application (ASP). Microsoft technology: SQLServer database with a Windows front end. Acclaimed Customer service staffed by health care claims experts with a minimum of 12 years’ experience in the field. Support calls are logged with status available via the internet. Plan copy and modification feature enable quick setup of plans. Auto-adjudication using benefit codes built using business rules based on over 25 variables from both the claim and the claimant records made available to the adjudication engine. Inbound claims can be scanned images, EDI or paper. HIPAA EDI 5010 transaction sets. Re-pricing fee and UCR Schedules can be loaded on the system in advance of the effective date. The date-driven logic will re-price based on the date of service. -
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I-CAPS
W.O. Comstock & Associates
I-CAPS is an Intelligent Claims Administration System that addresses all functional areas of the health claims payment environment with a single common architecture that spans the needs of payers including membership, billing, enrollment, mailroom, claims, network management, contracting, pricing, utilization review and customer service. Our Intelligent Claims Administration System (I-CAPS) and our coding compliance software (Advanced Value Scale-AVS) , support knowledge-based decision-making to help our clients contain costs. Guaranteeing the integrity of Provider information has never been easier with (Advanced Network Administrator-ANA) while our (RB-UCR) is the industry's first Resource-Based, Usual Customary, and RESPONSIBLE fee schedule based on RBRVS and NCCI. Need a check-up for your plan or provider, use Cost Containment Audit and Recovery Services (CCARS) for a completely noninvasive audit retrospective look at claims effectiveness. -
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The Rosemark System
Shoshana Technologies
We create the most powerful yet simple home care software applications to help agencies manage their most critical resources: people, payors, outcomes, and data. Business-building tools to record sales contacts, track and measure referrals, plan and assess marketing efforts, and more. Post job listings, track and screen applicants, ensure employee compliance, offer flexible scheduling, caregiver mobile app, EVV, telephony, and more. Offering the most intelligent and positive customer service in the industry, experience dedicated, proactive staff and one-on-one technical support, available 24/7 to ensure success and maximum ROI. Grow your business while keeping costs down with flexible pricing based on time scheduled or by client. Server security, data encryption, Secure Shell password protection, and routine backups ensure data safety and eliminate risk of data loss.Starting Price: $100.00/month -
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PlanXpand
Acero Health Technologies
PlanXpand™ is Acero’s proprietary transaction processing engine, one that powers each of our products for health benefits administrators. Leveraging this engine, clients may choose to implement Acero’s products concurrently or incrementally. In addition to selecting one of our standard products, administrators also may choose to utilize PlanXpand™ to develop a custom solution to extend existing system capabilities. Acero’s unique, integrated solutions feature Service-Oriented Architecture, allowing health benefits administrators and insurers to add features and functions to existing adjudication platforms. At the same time, our sophisticated design and engineering enables real-time adjudication of every type of claim, all in direct interaction with the core claims system, resulting in more accurate processing, more satisfied customers and less need for claims adjustments. -
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CLAIMExpert
Acrometis
The Acrometis flagship claims processing solution offers unparalleled workflow management, with documents automatically routed by a configurable rules engine. Based around claim assessment scoring, body part to claim compensability matching, jurisdictional directives, relatedness scoring and a host of other claim elements the Acrometis business rules are designed to reduce claim duration and costs. CLAIMExpert automatically processes 65 percent of incoming medical bills and non-medical documents with no user intervention. Documents requiring adjuster intervention are flagged and sorted for easy review and straightforward decision making. Automatically processes incoming documents with NO adjuster intervention. Clients typically see between 11 and 23 points medical loss improvement in the first year. CLAIMExpert contains rules for over 190 different document types, quickly handling whitemail and any other documents that come across your adjuster’s desk. -
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SSI Claims Director
SSI Group
Elevate your claims management process and decrease denials through unmatched edits and an industry-leading clean claim rate. Health systems require access to technology that facilitates accurate claim submission and rapid reimbursement. Claims Director, SSI’s claims management solution, streamlines billing practices and provides visibility by guiding users through the electronic claim submission and reconciliation process from beginning to end. As payers change or modify reimbursement criteria for services, the system actively monitors and incorporates these changes and requirements. And with a comprehensive mix of edits at the industry, payer and provider levels, the solution aids organizations in making the most of reimbursement efforts. -
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Total Loss Pro
Vemark
The frequency of total loss claims continues to rise, now accounting for some 20 percent of collision and liability losses across the auto insurance industry. Yet, far too often, carriers’ total loss operations lack cohesive integrated digital workflows, leading to excessive costs, customer dissatisfaction, and poor visibility and oversight. Enter Total Loss ProTM from Vemark. It’s the one solution you need to transform total loss claims processing from a frustrating black hole to a well-oiled machine while allowing you to keep up with the rapid pace of change. Faster settlement for Improved policyholder experience and satisfaction. Higher employee morale from reduced frustration, and fewer tedious processes. Increased visibility and transparency for data-driven decision-making. Auto claims that result in a total loss are more complex than vehicle repair claims. Total Loss Pro is a cloud-based solution that improves all stages of this complex salvage vehicle workflow. -
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ClaimScape
DataGenix
Emerged in the year 2000, DataGenix is strongly resolved to provide TPAs, adjusters, and insurance companies with modern claims processing solutions. We understand that claims processing and health benefits management can include several complications. So that your business does not suffer any losses, our experts have created the advanced ClaimScape software that can automate the entire adjudication process. The goal of our business and the Claims software is to resolve the perplexities that hinder the reach of unmatched customer experience for your clientele network. Keeping in mind the modern trends and requirements, we can assure your business's optimum growth with our software products. We have won the trust of top TPAs of the nation and are willing to serve more.